1. Overview of Prenatal Care
Melissa Knabe, CNM
Certified Nurse Midwife
Department of OBGYN
Slides courtesy of Dr. Suzanne Walczak

2. Goals
Understand the importance of prenatal care and general aspects of care
Understand barriers to prenatal care
Learn how to advocate for your patient

3. Prenatal Care
Ensure uncomplicated pregnancy and healthy mother and newborn
Identify those at high risk for common pregnancy complications

4. Prenatal Care in Wisconsin
~ 72,000 births per year

5. Prenatal Providers in US

6. Most Common Pregnancy Related Complications
Gestational Diabetes
Pre-eclampsia
Pre-term labor/delivery
Intrauterine Growth Restriction
Trauma or violence

7. Prenatal Care Schedule
1st visit at 6-8 wks
Every 4 wks until 24 wks
Every 2 wks wks
Weekly 36 wks until delivery

8. 1st Prenatal Visit Establish gestational age Identify Risk Factors
History
Physical Exam
Labs

9. Establishing Gestational Age
Last menstrual period (LMP)
Physical exam
Ultrasound

10. History Previous Pregnancies Gynecologic Problems
Medical and Surgical Problems
Medications
Smoking, Alcohol, Drugs
Nutrition
Psychosocial information

11. Routine Initial Labs CBC (Complete Blood Count)
Blood Type and Antibody Screen
Rubella Titer
Hepatitis B Surface Antigen
RPR (Syphilis test)
HIV
Urine Culture
Pap smear
Chlamydia and Gonorrhea cultures

12. Optional Labs Hemoglobin electrophoresis Glucose Challenge Test
Thyroid Stimulating Hormone
Tuberculosis Screen
Cystic Fibrosis
Genetic screening for high risk groups

13. Genetic Screening Trisomy 21 Trisomy 18 Neural Tube Defects
(Down Syndrome)
Trisomy 18
(Edward Syndrome)
Neural Tube Defects

14. Genetic screening 1st trimester 2nd Trimester Nuchal Translucency
Blood tests
Beta human chorionic gonadotropin (beta-hCG)
Pregnancy-associated plasma protein-A (PAPP-A)
2nd Trimester
Anatomy ultrasound
Alpha Feto Protein (AFP)
Estradiol
Inhibin A

15. Diagnostic Genetic Tests
Chorionic Villus Sampling
Amniocentesis

16. Routine Monitoring at Each Visit
Blood pressure
Urinalysis
Weight
Fetal Heart check
Fetal position and movement
Questions

17. Tests Later in Pregnancy
Anatomy Ultrasound (20 wks)
Screen for Gestational Diabetes (28 wks)
Screen for Group B Strep (35 wks)
Fetal testing if indicated
Non-stress test
Biophysical Profile

18. Important Counseling Preventable Birth Defects Seatbelt use
Intimate Partner Violence
Labor and Delivery
Breastfeeding
Contraception
Circumcision

19. Labor and Delivery

20. Labor “Contractions causing cervical change” <37 weeks = preterm
If no spontaneous labor by 41 weeks may induce labor
Rupture of membranes may occur before or after onset of labor

21. Cervical exam eg. “4/80/-1” Dilation (0 to 10cm)
Effacement (0 to 100%)
Station (-5 to +5)
eg. “4/80/-1”

22. Pain management Environmental and behavioral techniques
Parenteral Opiods
Epidural

23. Delivery Normal Spontaneous Vaginal Delivery Operative Delivery
Forceps
Vacuum
Cesarean Section

24. Post-Partum 2-4 days in hospital 6 weeks until maternal
physiology returns
to baseline

25. Barriers to Prenatal Care
Cost/Insurance
Time
Family Responsibilities
Education

26. Advocating for your patient

27. Advocating for your patient
You don’t have to know all the answers!
Help her frame questions
Help her understand what she can do to minimize identified risks
Respect the gift that she gives you of allowing you to participate in her care
Be aware of your limitations

28. Working with Staff Understand you are a guest
Introduce yourself and your role
Be conscious of the needs of other learners
Contact me with any questions/concerns

29. Resources UpToDate.com What to Expect When Expecting
MoMS Program Coordinator
Melissa Knabe, CNM
Office: